Question 1

At a unit meeting,staff discusses interior decoration for a special room for patients in acute mania.Select the best suggestion.

Accepted Answer

A)   An extra-large window with a view of the street.
B)   Neutral walls with pale,coordinated accessories.
C)   Brightly colored walls and print drapes.
D)   A rocking chair. B

Question 2

Appropriate suggestions for the family of a patient with bipolar disorder being treated as an outpatient during a hypomanic episode include: (Select all that apply. )

Accepted Answer

A)   providing structure.
B)   limiting credit card access.
C)   encouraging group social interaction.
D)   suggesting limiting work to half days.
E)   monitoring the patient's sleep patterns. A,B,E

Question 3

Which documentation indicates that the treatment plan for a patient with acute mania was effective?

Accepted Answer

A)   "Converses without interrupting;clothing matched;participates in activities."
B)   "Irritable;suggestible;distractible;napped for 10 minutes in afternoon."
C)   "Attention span 1 to 3 minutes;journals frequently about unit activities."
D)   "Heavy makeup;seductive toward staff;pressured speech." A

Question 4

Lithium is prescribed for a new patient.Which information from the patient's history indicates that monitoring of serum concentrations of the drug will be challenging and critical?

Accepted Answer

A)   Arthritis
B)   Epilepsy
C)   Psoriasis
D)   Heart failure

Question 5

A patient with bipolar disorder,mania,relapsed after discontinuing lithium.The health care provider prescribes lithium 600 mg BID and olanzapine (Zyprexa)10 mg BID.What is the rationale for addition of olanzapine to the lithium regime? It will:

Accepted Answer

A)   minimize the side effects of lithium.
B)   bring hyperactivity under rapid control.
C)   potentiate the antimanic action of lithium.
D)   be used for long-term control of hyperactivity.

Question 6

Laboratory results show a patient's lithium level is 1.0 mEq/L.Select the correct analysis.

Accepted Answer

A)   Within therapeutic limits
B)   Below therapeutic limits
C)   Above therapeutic limits
D)   Incorrect.Lithium levels are reported as mEq/dL

Question 7

A patient with acute mania approaches the nurse,waves a newspaper,and says,"I want the phone right now.I need to call this store while their sale is going on.I need ten dresses and four pairs of shoes." Select the nurse's best intervention.

Accepted Answer

A)   Suggest the patient ask a friend do the shopping and bring purchases to the unit.
B)   Invite the patient to sit with the nurse and look at new fashion magazines.
C)   Tell the patient phone use is not allowed until self-control is improved.
D)   Ask whether the patient has enough money to pay for the purchases.

Question 8

A patient with bipolar disorder is hyperactive and has not slept for 3 days.Mood and behavior are labile.The patient threatens to hit another patient.Which response by the nurse is appropriate?

Accepted Answer

A)   "Stop that now.No one did anything to provoke an attack by you."
B)   "If you try that again,you will be placed in seclusion immediately."
C)   "Do not hit anyone.If you are unable to control yourself,we will help you."
D)   "You know we will not let you hit anyone.Why do you continue this behavior?"

Question 9

A patient with bipolar disorder commands another patient,"Change the television channel.Get me something to drink…," and so forth.The nurse wants to interrupt this behavior without entering into a power struggle with the patient.Select the nurse's best approach.

Accepted Answer

A)   Distraction: "Let's go to the dining room for a snack."
B)   Humor: "How much are you paying servants these days?"
C)   Limit setting: "You must stop ordering other patients around."
D)   Honest feedback: "Your behavior is annoying other patients."

Question 10

A teaching plan for a patient taking lithium should include instructions to:

Accepted Answer

A)   maintain normal salt and fluids in the diet.
B)   drink twice the usual daily amount of fluid.
C)   have regular laboratory studies of liver function.
D)   avoid eating aged cheese,processed meats,and red wine.

Question 11

Which menu is best suited for a patient with acute mania?

Accepted Answer

A)   Roast beef,green beans,pudding with whipped cream
B)   Broiled chicken breast on a roll,ear of corn,apple
C)   Beef and vegetable stew,roll,strawberry gelatin
D)   Spaghetti and meatballs,salad,banana

Question 12

Which factors play a dominant role in the etiology of bipolar disorder? (Select all that apply. )

Accepted Answer

A)   Polygenics
B)   Substance abuse
C)   Variations in neurotransmission
D)   Birth injuries or alternations in prenatal development
E)   Dysregulation of the hypothalamic-pituitary-thyroid-adrenal (HPT
A)  axis

Question 13

A patient with mania has not eaten or slept for 3 days.Which nursing diagnosis has priority?

Accepted Answer

A)   Risk for injury
B)   Ineffective coping
C)   Ineffective management of therapeutic regime
D)   Imbalanced nutrition,less than body requirements

Question 14

After hospital discharge,a priority intervention for a patient with bipolar disorder who is taking antimanic medication is:

Accepted Answer

A)   decreasing physical activity.
B)   increasing food and fluids.
C)   meeting self-care needs.
D)   psychoeducation.

Question 15

Which assessment findings would be expected for a patient diagnosed with bipolar I disorder?

Accepted Answer

A)   Rapid cycling
B)   Major depression and acute mania
C)   Major depression and/or hypomania
D)   Hypomania and/or minor depression

Question 16

During the maintenance phase of treatment,a patient with bipolar disorder asks,"Do I have to keep taking lithium even though my mood is stable now?" Select the nurse's best response.

Accepted Answer

A)   "Do you feel you are ready to stop taking it?"
B)   "Taking the medication daily helps prevent future relapses and recurrences."
C)   "Usually patients take medication for approximately 6 months after discharge."
D)   "It's unusual that the health care provider hasn't already stopped your medication."

Question 17

The spouse of a patient with bipolar disorder asks,"What evidence supports the possibility of genetic transmission of bipolar disorders?" Select the nurse's best response.

Accepted Answer

A)   "A high proportion of patients with bipolar disorders are found among creative writers."
B)   "A higher rate of relatives with bipolar disorder is found among patients with bipolar disorder."
C)   "Higher rates of relatives of patients with bipolar disorder respond in an exaggerated way to daily stress."
D)   "More individuals with bipolar disorder come from higher socioeconomic and educational backgrounds."

Question 18

A patient with bipolar disorder was hospitalized 5 days ago and has received lithium 600 mg TID.The staff now observes agitation,pressured speech,poor personal hygiene,hyperactivity,and bizarre clothing.Select the nurse's best action.

Accepted Answer

A)   Consider the need to measure the serum lithium level.The patient may not be swallowing the medication.
B)   Include the patient in psychoeducational groups about personal hygiene,dressing,and grooming.
C)   Ask the health care provider to prescribe an increased dose and frequency of lithium.
D)   Continue to monitor and document the patient's speech patterns and motor activity.

Question 19

A patient with acute mania undresses in the day room and dances about.Select the best intervention.

Accepted Answer

A)   Quietly ask the patient,"Are you embarrassed? Don't you think you should put your clothes on?"
B)   Let the patient stay in the day room.Move other patients to a different area.
C)   Cover the patient with a blanket and walk with the patient to a quiet room.
D)   Tell the patient firmly,"Stop dancing and put on your clothing."

Question 20

A patient with mania dances around the unit,seldom sits or sleeps,and monopolizes conversations.Which nursing intervention will best assist the patient with energy conservation?

Accepted Answer

A)   Monitor physiological functioning.
B)   Provide a subdued environment.
C)   Observe for mood changes.
D)   Supervise personal hygiene.

Exam 14: Bipolar Disorders